Provider Demographics
NPI:1922594647
Name:ABI-RACHED, LAYELLE TONY (OD)
Entity Type:Individual
Prefix:DR
First Name:LAYELLE
Middle Name:TONY
Last Name:ABI-RACHED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26770 HYANNISPORT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2658
Mailing Address - Country:US
Mailing Address - Phone:216-644-4063
Mailing Address - Fax:
Practice Address - Street 1:1141 W REDONDO BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3585
Practice Address - Country:US
Practice Address - Phone:310-767-7814
Practice Address - Fax:310-323-3785
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA34411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program